HomeMy WebLinkAboutRuland (2) tL Town Hall, 53095 Main Road
® P.O. Box 1179
j Southold, New York 11971
JUDITH T.TERRY
FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1292-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RULAND, WILLIAM P.
Mailing Address 1 BOX 164, MILL ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000 •
Property Address 1 MAIN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner-Telephone No. 516-298-9159
Tax Map No. section 115.00 block 2 lot 2.003
Cross Street CORNER RT 25 AND MILL LANE
Date Of Last Pump Out 0/00/00
Issue Date: 11/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1
OFFICE OF THE TOWN CLERK -
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Town of Southold < �4 Application No.
Judith T. Terry, Town Clerk . 1 ': . y
Town Hall, 53095 Main Road c3=,r i $10.00 - Residential
p. 0• Box 1179 u-3 10-.40 $25.00 - Non-Residential
Southold, New York 11971
TelephoneYDj '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
•
DATE
OWNER NAME: \i f J/;�.rfl R RuiJ •
OWNER MAILING ADDRESS: 130)( ) 9, )7),`)
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OWNER- PROPERTY ADDRESS: 1'J)pt.r>n gc
pi a 7r,'Tocg,Pity,
OWNER TELEPHONE NUMBER: O9 /` - X159
TAX MAP NO. : Section //1/45—
f5- Block Lot
CROSS STREET: c6'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing /
Residential / < Non-Residential
DATE OF PREVIOUS PUMP-OUT: 76/1Ss f
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
A/IL
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Sig of Applicant
RECEIVED BY:
R' n Clerk's Office
DATE: NOV 01 19b
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